tv Government Access Programming SFGTV September 2, 2019 4:00pm-5:01pm PDT
if the police chief right here, he is not able to do his job, leave san francisco. maybe you do not need to be in san francisco. we need people who care about san francisco, not for african-american people but chinese people and other people also. for many months we chinese have been targeted. [please stand by]
here. i hope more police and more safety, you know, in our community, all the community, we appreciate it. >> president hirsch: thank you. next speaker, please. >> hi. my name is paula williams, and i'm homeless in san francisco right now. i've been homeless since december of 2018. i've made numerous police reports. i've been harmed numerous of times by staff in the shelters. the police have did me no justice. i've went to the city attorney, i've went to the d.p.a. it's just plain corruption. it's five police officers that don't want to take a police report, made false statements
in my police report. didn't want me to file a police report and just was lying. i liked when miss taylor said they wanted to take a look at the shelters. every morning, i walk-through t.l. and encourage them, tell them to get up, all to -- it's numerous of stuff that whatever hsoc and all of them is talking about, i just called the police yesterday in front of walgreens and had the police come up and pick a lady that was laying on the ground. sometimes i just do field work all day and call 911, can you please get this person up, can you please -- so i don't know what they talking about.
every day, i'm in the tenderloin. whatever salary they getting, they know me down there. they know me really well. so i think you guys should look up all my police reports, go to d.p.a., and ask someone that's working in the shelters that's harming, it was a 26-year-old girl that sprayed chemicals in a 66-year-old's face this morning. >> president hirsch: thank you. any other public comment -- general public comment? >> my name is john jones. may my remarks please the commission. about two years ago, i was getting on a 14 mission bus at the corner of geneva and mission, and all of a sudden, i heard this scream, a woman scream. and i looked around, and there
was a chinese woman in the back holding a very well cared for child, and three black teenagers were running off the bus. i came face-to-face with one of the teenagers, and he was smiling. apparentl apparently, one of them had just ripped a cell phone out of the woman's hand. now, the witness to that was five chinese men sitting in the back of the bus. my impression was that chai necessary have very tight families. i could run through the numbers, but my estimate is that 3,000 separate individuals heard a full recounting of that crime and the effect upon that woman. you cannot buy that kind of bad publicity. it's stupid.
for a $25 cell phone, you alienate all those people? that's one fact in all this crime that we talk about that doesn't get emphasized, the effect it has on others, particularly others of different races. thank you. >> president hirsch: thank you. any other public comment? >> i'd like to use the overhead again. i'm trying to start it. wait a minute. >> president hirsch: we need you to talk into the mic, though. >> i'm trying to start my video, so could you -- so -- wait a minute. sorry. just a second.
i think it's ready now. so -- oh, here we go. >> 12 years after his son was -- her son was shot and killed in san francisco, tonight, she's still pleading for answers and hoping a huge reward will lead to an arrest. our crime reporter has the story. >> i'm here. this is the 12 year. i'm back again. >> it's a sad summer ritual, paulette brown, pleading with san francisco police after her only son was shot and killed back in 2006. >> i was told back when it happened, it's going to get easier, but it doesn't. i can deal with it. i'm functioning. i work -- i do everything that i need to do, but this pain never, never ends. >> on august 14, 2006,
17-year-old aubrey aberkacen approached several gang members. police say aubrey wasn't a gang member, but he yelled at his friends to run, and they shot him in the back for this. like she does each year, she passes out fliers, hoping someone will be brave enough to come forward. san francisco police say a $250,000 reward remains in effect. >> i know it's been 12 years, i know it's been a long time, but if we can solve a case from the golden state killer that goes back for decades, we can solve one that's 12 years old. >> i can't believe he's been gone 12 years and nothing's happened. >> aubrey's mother and the
police say if you have any information, call police. >> so i'm saying august 14 of this month will be his anniversary, and i'm looking for you guys to come -- i'm having media coverage on grove and baker. steve -- david stevenson has already given me the flier to pass out to faith-based people. i'm hoping that coming here for all these years that you guys would accompany me and stand with us concerning unsolved homicides and mothers and fathers who lost their children to homicide so maybe some way we can heal. >> president hirsch: thank you. >> i would like to see you there. >> president hirsch: the tip line is 415-475-5555. any other public comment? next item?
[agenda item read]. >> president hirsch: is there any public comment on us going into closed session? all right. seeing none, public comment is closed. next item. >> clerk: line item nine, vote on whether to hold item ten in closed session, including vote on whether to assert the attorney-client privilege with regard to item 10-a, san francisco administrative code section 67.10, action. >> president hirsch: is there a motion? >> so moved. >> second. >> president hirsch: all in >> clerk: commissioner hirsch, we are back on record in open session. you still have a quorum. line item 11, vote to discuss any or all items held in closed session pursuant to section 57.12 a.
>> the second item on the agenda is the minutes of the meeting of july 6, 2019. >> the minutes are before you. we have a motion to approve after your review. any comments, commissioner? >> i would move that on page 10, under comments on section six, i would just add that the statement that i have there would seem to sound like ucsf
is the only other provider for the cardiovascular surgery, and that's not correct. i think my question was who were the other providers, and i think we heard that cpnc and kaiser. >> i will go back to the recording and clarify that. >> it sounds odd. >> thank you for the clarification, commissioner. >> other comments from commissioners? motion to adopt? >> so moved. >> second? is there a second? >> second. >> all those in favor, signify by saying aye. thank you, everyone. item three is the director's
report. >> good afternoon, commissioners, brian colfax, director of health with the director's report for august 6. so the big news is we are at the go live. we went live at 2:00 a.m. on saturday, august 3? so far, all systems are running well, and i just really want to thank the incredible team. literally hundreds of people, thousands of hours, millions of dollars to make this all work, but so far, so good, and while there certainly have been some issues brought forward as expected, the problem solving has acted at every level across the organization and the support for the clinicians, and i think most importantly our patients are continuing to receive the best care possible is really key. and you'll remember this was literally the go live for
zuckerberg hospital, laguna honda, and our clinics really connecting the data as never before. just to give you a perspective, many of us were at zuckerberg hospital for go lives. we were walking the hauls of zuckerberg general and same then for laguna honda, looking for that change. and yesterday was the big live because yesterday was our first full business day. there was some issues in terms of data expected to show up that didn't show up, but those things are being worked on as much as possible and then triaged by the great support teams. just to give you the numbers, zero patient harm events, so that's a good first step.
4700-plus service tickets opened, and the majority of those have been resolved, so that's a really key thing. and then, i think in terms of service desk calls, so far, there's been a less than seven-second two-time wait call for that, so really good data there. going down stairs to tom lidell clinic, i was talking to some providers, and literally, i turned to talk to someone else, and there was a person helping them, solve problems. keeping it real, i think there are some frustrations and challenges, but i think overall, we're expecting what is to come in the system change. and finally, i just wanted to state in meeting with the
ambulatory care leadership in the trailer at zuckerberg general. one person had gotten a low potassium on a patient that had come into the care clinics. and because of our generalized data, they were able to determine the person was at the sobering center and able to make sure that person's potassium was being corrected. before, we wouldn't even know where that person was. had to track down that patient, and this was a very clear example of how in the first few hours, we were making patient care better. i'm confident that there are hundreds, if not thousands of examples of that going forward. very excited and will provide more detail to you at our next commission meeting. i also wanted to mention on a few other pieces of our report,
we are continuing to cooperate with the california department of public department with regard to the laguna honda investigation, and we received a formal statement of deficiencies from cdph on july 3. we filed a response on august 2. it describes how we're implementing standards to establish standards set by our regulatory partners. i also wanted to remind the commission that we continue our operations center in response to the increases that we've been seeing in congenital
silv-silv syphil syphilis. i'm actually serving as incident commander for the month of august, so it's great to support an amazing team that's working on this and more focused on collaborating across the departments and communities so we reduce the incidents of congenital syphilis going forward. so you can read the rest of the report and i stand ready to answer any questions or comments. >> thank you, director. i did have a question on the go live. is there anything you're especially hypervigilant, especially things that might
still be coming up. even though things have gone incredibly well -- too much to expect. >> well, i think the things we're most hypervigilant about is making sure that the data that's there when a patient is coming in so that the provider can prepare the best care possible? also with a mapping from older systems to the new epic system that there have been occasions in the system where the mapping didn't go to where we thought it would go, so correcting for that quickly and effectively. i think also because of the workload that continues to be in the clinics and in the hospitals, that we're ensuring that providers have the support that they need in order to continue to provide the level of care and services? and then i think finally that we're provide the work necessary so they're not workarounds that could harm our system, so making sure that
people aren't going outside of the established protocols that are necessary for the whole system to function? and i think what's really key, and i just want to acknowledge this because it can't be said enough is that the super users in that person-to-person support, and when you look at epic and the implementation, it's about making sure -- we just had a discussion at the finance committee, that there's robust numbers to help people problem solve is really key. >> thank you. >> any questions or comments from commission? commissioner? >> yeah. i had two. one was on the hunters point shipyard building 606, which was the police department, how are they accepting the report and how are we working with
them? it was a great report that they are not now in danger. have they received that in a positive fashion or is there still dialogue with them because this was a huge -- >> yes, yes. so dr. aragon will provide some details of that, and thank you for pointing out. i did skip that item in the report in the interests of time, but dr. aragon has more details. >> good afternoon. is the question about building 606 or is it about parcel a? >> building 606 because that's all the report is on. it says that we've come to a -- we've come to a report saying that there was no problem. >> correct. so they did extensive testing both -- they did a radio logical scan looking to make sure there was no exposure? they also did dusting, and they
also did dust testing for asbestos. so all the testing that has been done over the years has been negative. the only problem they did find was early on, there is some lead levels in the water, so they've been providing bottled water for that site for years, so no one's had any exposure from the lead to the water. >> so that's same accepted -- are they still occupying the building? >> yes, the building is still being used, and the building is completely safe. >> okay. >> and since the late 1990's, we've had an industrial hygienist from d.p.h. based at the building to provide not only testing but also address concerns over the years that has come up. >> no, that's helpful. as you know, public reports have sort of portrayed it otherwise. >> yeah. most of the reporting has been primarily about parcel apartment where they have
apartment buildings. i know people confuse them. that's why i brought it up, because that's the perception people have. >> thank you. >> yeah. >> my other question was in regards to the supplemental budget. administratively, we had some decreases in the recommended budg budget which were not going to affect your administrative capacity. but then, with the new proposed programs, is it that we are going to be able to put those in feis in the budget year that we're talking about? or were they already there and we're now just getting more funding for it or whatnot? >> so i can get you more information on that -- that specific one? oh -- hello.
i will let our budget director respond to those questions. >> yeah. commissioners, jennie lui, d.p.h. budget director. they are ambitious. most notably is the $2 million you see for residential treatment for youth. the parentheses you see, it means we have two years of funding for it? so we can spend that allocation over two years. i expect it will be a new program, so we're going to have to identify, so it's not started up at this point today, but we will work with identifying an available c.b.o. through appropriate contract to get the services started, and then, we have the ability to carry forward the funds into the second year. and some of these are potentially continuing projects and some that are new. so we will work with contracts
and michelle rugals' staff over the course of the fiscal year. >> okay. thank you. >> any other questions? next item, please. >> there's no public comment request for that item. item four is general public comment. i've not received any requests. i'm not seeing any now, so we can move on to today's report on the budget and finance planning committee. >> the budget and finance planning committee met immediately before this meeting. we reviewed a few separate contracts. there are four separate contracts to provide pharmacy registry services through december 31, 2021. two of them are existing --
existing contractors and two of them are new contractors. so as we'll be considering in the next item, the consent calendar, there's a caveat on those two new vendors, we will receive to the board to review, and the secretary, mark, will be getting those. the reason that we need of course these pharmacy registration temporary personnel services is to cover vacation times, times when there's high vacation activity, and times when persons are being trained on epic. we have additional contracts with regard to network and security support services as well as epic go live activation and adoption plan. and then, we have three different contracts relates to healthy -- related to healthy sf and kid is in particular.
i would like to say that while healthy sf is being sunseted because kids are being moved on to medicaid, that is everything that is on the consent calendar. >> commissioners, questions? comments? >> we can move on to item six, which is the consent calendar, and as commissioner bernal stated, the committee approved the report with the understanding that i would receive the board of directors from the two new vendors with the understanding that i could forward them all to any questions that you have about that. >> thank you. we're going to call for a vote. so all those in favor.
>> of accepting and adopting the finance committee report. >> all right. and i'll note that there's no public comment request for that item. item seven -- items seven and eight are going to be presented together. item seven is the closure of st. mary's cardiovascular center, and the other is st. mary's spine program. >> i wish to recuse myself for these two items. >> and commissioners, dr. kol f -- dr. colfax, and i am recusing myself. >> oh, and commissioners, and i'm sorry, for the public, these items were introduced at the last meeting, and today, you will vote on them.
>> all right. good afternoon, commissioners. i'm here today for the second of two scheduled proposition q hearings on closures at st. mary's medical center, and the first hearing took place on july 16 at the last meeting. as a reminder on april 29 of 2019, st. mary's notified the health department of two closures. the closure of the cardiovascular surgery program, and the closure of the spine center, which is a licensed hospital outpatient clinic. you all received a memo that had detailed information about the closures? and for today's hearing, you received a memo that contained additional information based on the information that was requested during the last hearing. so for today's hearing, i'm just going to be briefly sharing points that are
addressed in the full-out memo. i do want to note that dr. david cline, director of st. mary's medical center are here to represent st. mary's and answer any questions about this brief presentation. all right. so as a follow up to the health commission hearing on july 16, st. mary's provided data on the number of plans versus emergent cardiovascular procedures. to look at this chart, there are four types of surgical patients? elective, meaning, the patient waits at home or the surgery is scheduled far in advance. the next is urgent. next is emergent, meaning the patient is very sick and it is not safe to wait for surgery. and then finally, it's emergent salvage, which means that the
patient has no pulse. and so based on st. mary's data, the percent of total cardiovascular surgeries that are nonelective vary from three to year, but from 2013 to 2018, about 30% of nonelected cardiovascular surgeries. it should be pointed out that since 2011, st. mary's hasn't had any emergent salvage procedures. so upon the closure, it's the nonelective cases that will likely have to be medically transported through van nuys or parnassis as those are the closest hospitals to st. mary's that officer cardiovascular surgery. so then, looking back at the 2018 data, that would account for approximately eight cardiovascular surgery case that's would have needed to be
medically transferred. so a few questions raised in the hearing were about surgical and nonsurgery card know vascular patients. with the closure, they're going to be referred out if surgery becomes necessary. so regarding the ability of physicians to follow their patients who are referred out of st. mary's, st. mary's has stated that they're fully supportive of their cardiologists practicing as other hospitals and realize that some of their cardiologists already do practice at other hospitals. so while saint mary's don't have a comprehensive list where their cardiologists provide active duty care, they did provide a roster of their cardio laskar care and the
location of their offices? so some have offices located at cpmc pacific, van nuys, stanford medical center, ucsf parnassis, and at al alta bates summit center in oakland. st. mary's cardiovascular surgeons are also credentialed at other san francisco hospitals? and that includes cpmc, ucsf, and kaiser. all right. also during a last hearings, there was a few questions about transfers? the map shows the locations that offer cardiovascular procedures that are comparable to the services provided at
st. mary's. so for san francisco, this includes ucsf parnassis. and then, for other cardiac care services, cpmc, ucsf, and kaiser all have cardiac catheterization labs, and those hospital locations are designated stemi centers, which means that they're equipped to treat emergent coronary heart attacks. so for any cases that need to be medically transferred from st. mary's, patients will go to
cpmc vanness or ucsf parnassis. so regarding a network of care through a review of the accepted insurance plans that st. marquis's accepts, all but one plan is accepted by cpmc and ucsf? both especially medicare, medi-cal, and chai -- accept medicare, medi-cal, and chinese community health plan. went too fast. so another question was also raised about hospital capacity and the current ability of san francisco hospitals to take on the average of 30 patients that are seen at st. mar he's's annually for cardiovascular surgery? and st. mary's has stated they've had conversations with cpmc and ucsf, and they're
knowledgeable about the case log and they're prepared to take on these patients. it should be noted that cpmc and ucsf have higher volumes of hard yo la cardiovascular patients than st. mary's. and then, finally, as a part of the formal transfer protocol that i spoke about at the last hearing, both were spoke about during that transfer protocol with st. mary's. okay. so to close, i'd just like to restate the conclusion that was presented during the july 16 hearing? in that despite st. mary's low surgical volume in the general advancements in minimally available surgical technology, san francisco does have a
growing older adult population and card low vascular surgery services are going to become increasingly important? that the closing of the cardiovascular surgery unit may also have impacts on the level of care provided and the complexity of patients that may be able to be seen? and that finally there will be an average of 30 patients annually who can no longer receive surgical services at st. mary's. so the closure is a reduction in services, and for that reasons, and the reason spoken before, the closure will have a detrimental impact on the community. so i just want to note that on page seven of the packet, the memo follow up, you will find an amended resolution, 19-11 for the closure of the cardiovascular surgery unit? and the regulation in your packet includes red lines, based on the discussion and feedback that took place at the july 16 hearing? and then specifically as
suggested by commissioner chow, i added statements about the history of st. mary's and their impact on the field of cardiovascular surgery. and so that concludes my statements about the cardiovascular closing, and i'm happy to take questions, and the staff from st. mary's is happy to take questions. >> i'm dr. david cline, the president of st. mary's and also st. francis. i know there is a question regarding quality adult afrom the program, and we were able to go back to ashpa data, up to
2016 to show that the program had good quality. most of the quality that's occurred in quality analysis up to that point is discussed through our quality cardiac care committee, and i'm told even though i've only been there a short period of time that the quality has been good throughout the program, but we're not able to share specifics because of patient privacy concerns. >> thank you. is there any public comment? >> there's no public comment requests for this item. >> this item is in the hands of the commission. dr. green -- commissioner green? >> i remain confused about this balance between patient volume and safety because even if the surgeons are operating in personal sites and there are have a lot of personal surgical experience, these types of surgical procedures require quite a large team to make sure that from admission to discharge, these patients have the highest quality of care.
so i wonder if somebody can elaborate more on that. i wonder if there are only 11 cases as you listed here, and the ancillary question -- i'm not a cardiologist, but i've read a lot about the safety of p.c.i. in the context of lack of available in immediate cardiac surgery. there was an article not that long ago saying it is quite safe, but if you have the choice to do the procedure electively, it's probably better to go to a place with surgery. i formed a different conclusion than the literature, and i wonder if you knowing more than i can comment on those two elements. >> sure, commissioner green. i think it's clear from the literature that low quality programs don't have the outcomes that we do. when you look at -- when you look at the regulatory bodies,
a lot of them don't speak to organizations except leapfrog, and when you look at leapfrog, they're not able to maintain the individual competencies of the team to not able to care for those patients. regarding the p.c.i. question, i think it is the standard of care to operate freestanding cardiac cath labs. i've operated a number of them in other states and including here in san francisco and that was at zuckerberg general hospital. the answer is because they are so precise, there are seldom complications, and when there are, you have some time ahead of you to transfer those patients to locations where you have cardiac teams standing by. back in the day when i was a surgeon, stand by is different than it is today. the team is prepped and ready to go in case you had a complicatio
complication] there's no longer -- that's no longer the case. it could know take an hour to -- now take an hour to two hours to get a physician back when you have a system setup for the patient, it really is beneficial for the systems and care of the patients. >> commissioner green? >> thank you. can you comment at all about what the future holds in terms of cardiac interventions? it seems that pervasive
cardiology is a lot less common. i'm wondering if -- as we look at the demographic shifts in san francisco, can you comment on the ratio of procedures that you might -- that might be anticipated. >> i would say over the course of a number of years, clearly, the last 20 years of volume of open cardiac surgery has decreased. i think if you add up the numbers, there's probably less than 1,000 that's done annually. if you look at it years ago, it was double or triple. the numbers regardless of age have gotten much, much better. and although there's still going to be cases for open cardiac surgery, those numbers are going to be less because of the advances made in noninvasive cardiac care. there might be some procedures
that have a notable risk, such as a transaortic procedure, things you wouldn't do in a cath lab, but we intend to continue the cath labs and most of the physicians that perform those procedures can be performed in a freestanding clinic such as what we intend to have. >> thank you. >> thank you. >> commissioner? >> thank you. we've received letters from some of your surgeons who maintain they would be comfortable in maintaining the current type of surgeries at st. mary's. are you confident that they support this move and understand the reason for it but would otherwise then
continue to bring their cases to st. mary's or will this begin to affect that? >> you know, i think that all things being equal, i think they would prefer that we keep the program open. i think there's a lot of emotion surrounding the discussion because it's been a long-standing cardiac surgery program. like any closure, there's going to be a period of mourning when we stop to do those procedures. but likewise, when we explained our concerns and our inability to maintain staff quality, although they don't love it, they do understand that it's just -- you know, we did 14 procedures last year. we just finished up our count for last fiscal year. we did 15. we just can't assure safety and quality, and they understand that, but i think all things
being equal, they would like to keep the program. >> commissioner green just sent me a copy of the new england journal of medicine from october 2012. they listed sort of a table of characteristics for p.c.i. programs for that on-site cardiac surgery, part of which was to adhere to the relevant guidelines within the cardiovascular -- and i'm sure you're well beiacquainted withe paper. because the paper didn't say one or another way but explained some of the complications that could occur which were actually much more the reason for the difference in favorable results between high volume and low volume, but
facilities that have cardio thoracic surgery, for those problems that arise. would it be -- and i imagine st. mary's meets most of those criteria. >> yes, sir. >> and so that would actually be what you would be following in order to try to maintain the competence of these cardiologists and their staff. >> yes. there's selection criteria for what we can do and can't do, but ultimately, we would leave it in the hands of the practitioner what they're comfortable with. we would never second guess the physician's decision, but i think there are standardized guidelines as to what is appropriate to do in a freestanding center and what's not, and we will adhere to those. >> and in the papers that commissioner green circulated
as background, there was somewhat a suggestion that the recipients to treatment may actually be made to be -- should be made aware whether or not cardio thoracic surgery would be valuable or how it would be valuable. is that something that you're all planning to do also in terms of disclosure to patients? >> yes, sir. that's part of all the possible outcomes, what we're able to do and not able to do. that's not just in cardiovascular surgery but any surgery, that's correct. >> but your most recent example was impressive, to say that in an hour you can be at ucsf in the operating room. >> yes. >> would that be part of the disclosure that there is a transfer arrangement? >> yes, absolutely, that is a part of disclosure, that in the
event they need advanced surgery, they are aware pre-op ratively that they would be transferred should that need arise. that's very explicit. >> thank you. those are my questions at this point. >> mr. secretary, we -- the resolution is within our packet. are we going to read the resolution before we take a vote on it? >> we usually don't, but i'm happy -- whatever you would prefer to do. and the vote is on -- the bottom line is whether it's detrimental or not. >> before we get to that, i want to thank miss lindsey and dr. cline for your testimony and for your presentation to us as a commission. so that is in the -- this is in the hands of the commission. we have seen the resolution. a motion is ordered to either -- it will have a detrimental impact or it will
not have a detrimental impact on health in san francisco. so is there a motion on either one of those options? >> and again to remind you, the d.p.h. has reminded you to vote it is detrimental. >> mr. president, i would move that it would have a detrimental impact on health services in the community and i would like to explain my reason. >> go ahead. >> recognizing that st. marquis's has tried very hard to preserve a -- mary's has tried to preserve a service that they were a pioneer in the nation, it doesn't negate that we have one less choice and one less possibility even though patients may be placed at a
greater risk and they are aware of that risk, i think it's commendable of st. mary's to say this is a program that they can continue or wish to continue because of the issue that may arise in terms of quality and due to low volume and all the other reasons that we have heard. i don't think that changes, however, the fact that san francisco will have lost one unit. and whether or not there are other units throughout the entire bay area or even nearby, the choice of st. mary's has -- is a detriment. it's a detriment to chinatown because the cardiologists that they've been working with and the cardio thoracic team were people that were acquainted with them.
and while they have privileged with them, i think the culture sensitivity that st. mary's has given to members of that community cannot be underestimated, and i think that will also be part of the detriment in terms of losing this service to our community. >> is there a second to commissioner chow's motion? >> second. >> call for the vote. all those in favor, signify by saying aye. opposed? hearing none, the resolution is adopted. >> i'm sorry. i missed that. i was helping someone else. >> the closure will have detrimental impact. >> okay. we can call the next item. >> all right.
so as a reminder from the last hearing, st. mary's plans to close the spine center, but the s.f. center plans to open a spine center just two floors above the current clinic at the st. mary's center. the closure of the spine center should not have a detrimental impact on the community. there wasn't much follow up since the last hearing. you'll find the follow up, and specifically the finding of the closure is nondetrimental is conditional upon what i just
said, the staff maintaining the current level of services. st. mary's can provide a timeline and opening. >> thank you. dr. cline? >> thank you. as of today, we have yet to file a formal request with the attorney general's office. once that starts, we will keep the commission informed and regularly update to what the status of that is. in specific regards to the hospital employees, as previously mentioned, there were five employees which could be affected, two of which have been given positions in other areas, and the other three are waiting to see what will unfold with the new facility. we are waiting to see if they will hire those three individuals, but they haven't
to date. >> thank you, dr. cline. questions for miss lindsey or dr. cline? i don't believe there's any public comment. i don't have any slips here, so we're going to move to adoption of the resolution that it will not have a detrimental impact on the health of san francisco. >> so moved. >> second. >> all those in favor, signify by saying aye. the resolution is adopted. >> thank you. >> all right. so we can move to the next agenda item, which is agenda item